Procalcitonin versus C-Reactive Protein in Neonatal Sepsis

Abstract

Objectives: To compare between C-reactive protein (CRP) and Procalcitonin (PCT) regarding diagnosis and outcome of neonatal sepsis. Urinary tract infection (UTI) is the most common serious bacterial infection in febrile children younger than 3 months, with reported rates ranging from 5% to 20% depending on different series. Neonates and infants up to age 2 months who have pyelonephritis usually do not have symptoms localized to the urinary tract. UTI is discovered as part of an evaluation for neonatal sepsis [1]. Neonatal sepsis is a clinical syndrome of systemic illness accompanied by bacteremia occurring in the first month of life. The overall incidence of primary sepsis is 1-5/1000 live births. The incidence is much higher for very low birth weight infants (birth weight<1500gm) [2]. Since the clinical manifestations of sepsis in neonates are non-specific and associated with high morbidity and mortality, early suspicion and treatment before blood culture confirmation is crucial [3]. The mortality rate is high (13-25%) with higher rates seen in premature infants, those with early fulminant disease [2] and those with increasing severity of inflammation. Background Procalcitonin versus C-Reactive Protein in Neonatal SepsisThe most severe infection is complicated by systemic inflammation and septic shock. However, to start therapy, an early reliable diagnosis is necessary [4]. Clinical signs and symptoms of infection often don't point towards the etiology. The diagnosis of sepsis is difficult because of non-specificity of clinical signs and symptoms and overlapping of symptoms with other noninfectious causes of systemic inflammation [5]. Elevated CRP levels are seen in infection, autoimmune disease, surgery, meconium aspiration and recent vaccination. Also, the CRP values do not rise significantly until almost 24-48 hr after the onset of infection [6,7].Participants: Seventy newborn Infants admitted to NICU for sepsis management.Results: Of the total 70 Neonates admitted in NICU, 31.4%, 42.9% and 25.7% were categorized as proven sepsis, suspected sepsis and clinical sepsis respectively. Procalcitonin was positive in 100% compared to the CRP positivity in 63.6% of the proven sepsis cases. Mortality rate is significantly increased in proven sepsis compared to clinical sepsis.Intervention: Sepsis workup laboratory tests. Main Outcome Measures:Specific diagnostic and prognostic impact of the tests. Conclusion:Comparing with CRP, PCT is not only a good diagnostic measure of neonatal sepsis but also effective predictor of sepsis outcome.